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Why Dentists Extract Wisdom Teeth
Sometimes, wisdom teeth come in normally and provide the mouth with another set of powerful, food-crushing molars. Unfortunately, that is the exception and not the rule.
It seems like pretty much everyone has their wisdom teeth (third molars) extracted before they come in around the age of 18. A lot of people wonder why our bodies even bother to make wisdom teeth if we just end up removing them. That's a good question.
One theory is that a long time ago people lost teeth a lot earlier due to poor oral hygiene and the third molars came in later in life to provide fresh, healthy teeth. Since some teeth had already fallen out, there was room for the wisdom teeth.
Currently, wisdom teeth are usually extracted as a preventive measure so that other problems do not occur later in life.
The reasons dental professionals remove wisdom are many, but they all boil down to one main reason – there is simply not enough room in the mouth for wisdom teeth.
There Isn't Enough Room for Wisdom Teeth
Here are a few reasons why dentists normally extract wisdom teeth:
- There isn't enough room in the jaw for them to come in.
- There won't be enough room in the mouth for them to come in.
- Due to lack of space, wisdom teeth often come in at an awkward angle and can damage adjacent teeth.
- If they never break through into the mouth, they can cause big problems later on.
- Since they are so far back, they are harder to clean. This increases the likelihood of developing cavities and gum disease.
There Isn't Enough Room in the Jaw for Wisdom Teeth
You can barely see the wisdom tooth poking out of the gums. There is not enough room for it to fully erupt.
Some people have smaller bones than others. Sometimes, the jaws are not big enough to contain all of the teeth that our bodies produce. After taking a diagnostic x-ray, your dentist can best advise you as to whether or not you will have enough room in your jaw to allow the wisdom teeth to erupt normally.
There Won't Be Enough Room in the Mouth for Wisdom Teeth
Sometimes wisdom teeth can't come up far enough into the mouth to serve as functional teeth. In some cases, the wisdom teeth only partially erupt into the mouth and can result in severe pain in the gingiva (gums) when biting.
You can see an example of this in the photo to the left.
Wisdom Teeth Come in at an Awkward Angle
Wisdom teeth usually have a tendency to be abnormal. They sometimes look very different and often they come into the mouth at different angles due to a lack of space.
As you can see in the x-ray to the right, the upper wisdom tooth is pointing backwards and the lower one looks like it is going to run into the tooth in front of it.
Many wisdom teeth try to erupt into the mouth by pushing on the molar right in front of it. This can make it easy for the adjacent molar to get a cavity. It can also cause the gums to recede around that tooth. This can sometimes severely damage the adjacent molar that both it and the wisdom tooth need to be extracted.
Wisdom Teeth Can Cause Big Problems Later On
One of my professors at dental school showed me an x-ray of a patient that never had his wisdom teeth extracted. Even though this patient was in his 50's, an infection had started around his impacted wisdom tooth. This resulted in a necessary surgery that cost thousands of dollars. This surgery could have been prevented by simply removing the wisdom teeth at an early age when the tooth and roots were small and still forming.
When a tooth is just sitting inside the jawbone for many years, it can form what is called a dentigerous cyst. This cyst can eventually turn into cancer.
Wisdom Teeth Are Hard to Clean and Often Get Cavities
The brown spot on the far back tooth is a cavity
Some of the patients that I see at the dental school have their wisdom teeth. In many cases, they complain that they are very hard to clean. They say that it is almost impossible to brush and floss way back there.
Because of this, many wisdom teeth develop cavities. If someone can't clean their wisdom teeth, then it's a good idea to get them taken out before they cause pain and problems.
In the picture to the left, you can see a young man's teeth. The last tooth in back is the wisdom tooth. It looks like the very back of the wisdom tooth was very hard for this young man to clean. Because of this, he developed a cavity and it looks like the tooth probably was extracted.
Conclusion
Do you have any questions about getting your wisdom teeth out? Do you still have your wisdom teeth? If so, have you had any problems with them?
Please leave any questions or comments below in the comments section, and I'll get back to you. Thanks for reading!
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Hi, I'm Tom. I'm currently a 4th year dental student in the USA. I started this blog to help people take better care of their teeth. You can 
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Hi Tom, love the website. I work in Afghanistan and help train Afghans to go into local schools and do oral oral hygiene education so it's good to get tips from here. (No, I'm not a dentist, I'm talking about simple education like 'brush your teeth!') We're also interested in A.R.T (http://www.whocollab.od.mah.se/expl/artmore.html)
I am 27, and I don't have my wisdom teeth yet. The one in the 2nd quadrant has partially erupted (about the same amount as the one in the photo, above) three months ago, and has stayed static since. I have no pain. I don't have easy access to good dental care. As long as it continues to be painless, do you think it's fine to leave it for a year or two, until I come back to England for a visit?
Appreciate your time,
Dan
Hi Dan - Thanks for all of the kind words. I love writing on this website - it's a nice break from cramming for quizzes and exams!
The A.R.T. sounds really interesting. I hadn't heard of it before, but it seems like a great way to bring dentistry to everyone in a less traumatic way. I'm sure that using hand instruments only to remove decay would save more tooth structure, too.
As for your question, I do have a patient right now who has all of her teeth, including her wisdom teeth - they came in fine for her. On some people, wisdom teeth do come in eventually without any problems. Have your other wisdom teeth come in, or did they just stay put under your gums? If I were in your situation, I think I would just leave it in if it's not causing any problems. A lot of the major problems with wisdom teeth (like cysts) occur when they are completely buried inside bone and are unable to come into the mouth.
Consider yourself lucky, too. Many of the people who come into our school through the Emergency Department have some sort of problem/pain with their wisdom tooth and they need us to take it out.
Let me know if that helps. It sounds like you're doing a great thing in Afghanistan, keep up the good work!
I actually wanted to write an article about whether or not a person should get their wisdom teeth out. I've read over this article about wisdom teeth extractions.
From the guidelines they state, and assuming you don't have any pathologic conditions associated with your wisdom tooth, it would appear that you don't need yours removed unless it is causing damage to the roots of your second molars (which a dentist could let you know with an x-ray.)
Here's a paragraph from the article you might be interested in:
"With regard to asymptomatic impacted third molars either partially or fully encased in bone, it would seem sound clinical practice to leave them and monitor them periodically based on the available evidence. Studies have all demonstrated that these teeth improve in angulation and vertical position with time, especially in the first three decades of life and beyond, but to a lesser degree. Extracting them early when individuals are in their teenage years simply leads to a more invasive surgical extraction procedure, increasing the likelihood of complications and it also prematurely commits them to extractions when the third molars may not have caused any problems or may have erupted favourably in the future."
I hope that helps, Dan.
Thanks for your response, Tom. Appreciate it. I'll leave my molars alone until I can get to an x-ray machine! Hey, just writing a project proposal at mo for our work...if you know any organisations that like to get involved with pioeering dental/OHP charity work with the poorest of the poor, let me know!
I'll let you know, Dan. My school used to do externships, but I think there was some sort of problem with liability, so they have one of the student associations sponsor them, which means a lot less money. We usually go to Central/South America, but I'll get in touch if we get more funding and people in my class are looking for places to go. Thanks!
Alright...nice one. Hope classes continue to go well.
Hi again,
Sorry to post twice under one article, but I couldn't find another area that seemed to fit for my question.
My son has a wisdom tooth coming in, and the gums are all swollen around the area where it is coming in. It is a little tender as well, but there is no actual tooth pain. He also has a terrible taste in his mouth, and his mouth smells bad. To me this signals infection. He went to the doctor, and they prescribed chorohexidine mouthwash, which he tried for two weeks. It didn't do any good. I think he needs antibiotics, but the doctor doesn't want to prescribe them. It is difficult to get him to the dentist right now, because he is a senior and says he can't miss even one day of school. The tooth just doesn't seem to want to break through. It has been like this for over two months. Do you think he needs antibiotics, or would they need to cut the gums or something?
Edit by Tom: Kera - I moved your comment to this article as it seemed more in line with wisdom teeth.
Hi Kera - This sounds like something known as periocoronitis. Peri means around, coron means crown of the tooth, and itis means inflammation - so it is literally an inflammation around the tooth. If you look at the picture above of the wisdom tooth barely sticking out through the gums, it might resemble what's going on in your son's mouth.
Sometimes there's just not enough room in the mouth for the wisdom tooth to fully erupt and it comes in halfway. If any part of the wisdom tooth breaks through into the mouth, it gets exposed to all of the bacteria in the mouth. Over time, if the wisdom tooth stops coming into the mouth due to lack of room, the bacteria can flow under the gums and all around the wisdom tooth. Since the part of the wisdom tooth under the gums is hard to clean, it makes it really easy to get an infection there.
Here's what my oral pathology book has to say about pericoronitis:
"Acute pericoronitis is treated with gentle antiseptic lavage under the gingival flap to remove gross food debris and bacteria. Systemic antibiotic agents are used if a fever or general symptoms are noted. The patient is instructed to use warm saltwater rinses and to return in 24 hours. Once the acute phase has subsided, the tooth can be extracted...If tooth retention is desirable, then the overlying gingival flap is removed surgically, followed by elimination of all food debris and bacterial colonies through curettage."
In my dental school, we were taught that antibiotics are not effective against pericoronitis. If you think about it, that kind of makes sense - if there's a piece of food stuck under the gums by your son's wisdom tooth, there's really no way for antibiotics to kill the bacteria living on that food. The book I quoted above states that you can use antibiotics if the infection has caused a fever or illness throughout the entire body.
The way to treat pericoronitis is to cut away the gum tissue above the wisdom tooth if there's room for it to erupt all of the way into the mouth, or to simply have your son's wisdom tooth removed.
I hope that helps! If you have any other questions, feel free to leave another comment.
Thank you so much again! Cheers
i Have a question that has nothing to do with this but it has to do with your teeth what is that average age a person would grow in wisdom teeth? I am 26 years old and nothing yet. I havent been to a dentist in a long time well since i was 17 but when i went then they said i didnt even have any back there at all. is that normal and are they still gonna develop them or do i just not have any?
Hi Crystal - The wisdom teeth usually come in around the time you become an adult. The average age is usually between 17 and 21 years. My guess is that you either don't have wisdom teeth or they are simply impacted, which means that they are stuck under the gum-line because there is simply no room for them to come into the mouth.
I hope that helps! If you have any other questions, feel free to leave another comment. By the way, I think I'll move this comment to this article on wisdom teeth as it may be more relevant there. Thanks!
Hi. I stumbled upon this site because I'm having apprehension about my daughter having her wisdom teeth extracted. Let me explain.
A few months ago, she had terrible ear pain. I took her to her pediatrician and he suggested that it may be her wisdom teeth. There was nothing he could find wrong with her ears. I had taken her for a consult with an orthodontist about 2 months before this and in the x-rays, her top wisdom teeth are growing straight out instead of down. As far as we can tell, they have not broken the skin yet, but that orthodontist warned that she would soon have problems.
I called her regular dentist and explained what her pediatrician thought and explained the x-rays I saw during the consult. She referred us to an oral surgeon. She hasn't seen the x-rays because the consult was free and then the oral surgeon's office called and informed me that my daughter has an appointment for surgery in 2 days. I'm not even sure she needs surgery and I have never met this surgeon before.
Am I being paranoid that it is happening so fast? I would think that the surgeon would have at least called for a consult before scheduling surgery. I'm so confused. Any feedback would help.
Thank you!
Hi Crystal - I'm sorry you're not having a good experience with your daughter's dental healthcare team. From what I understand, the dentist will usually monitor your child's growth and ultimately determine if your daughter needs her wisdom teeth removed. If the dentist doesn't feel comfortable removing them (most general dentists don't - that's why we have oral surgeons!) then the dentist will refer you to an oral surgeon to have the procedure done.
Personally, I don't think that the best thing to do is to call the patient and tell them when they have an appointment. It definitely does sound like you're being rushed. I don't think you're being paranoid. Getting wisdom teeth out is surgery, sometimes things can go wrong. It is your RIGHT to be informed of all treatment alternatives and the pros and cons of each alternative (in your daughter's case - taking out the teeth or keeping them in.)
The Principles of Ethics by the American Dental Association says that "The dentist should inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions.”
This is known as informed consent, and I believe that many dentists spend too much time rushing patients into treatment rather than clearly explaining all of their treatment alternatives. If I were you, I would either call my daughter's dentist or call the oral surgeon and ask for a separate appointment to go over the x-rays and what exactly needs to be done.
By the way, if x-rays were taken of your daughter, you have a legal right to have them as her health records belong to her (or you because she's a minor.) You can read more about that in the article How to Get a Copy of Your Dental Records.
I hope that helps, Crystal. Thanks for your comment!
Thank you so much. Actually, it was a bit rushed in my opinion, but the surgeon took his own x-rays and instead of just her top ones having to be removed, her bottom ones had to be removed too. He walked me through every single step, but only after we showed up for her appointment. He even explained why we got referred to him. I am just returning from her surgery and she is doing fine. She is a bit groggy from being put under but other than that, she is enjoying the milkshakes I was told to give her. I do have one concern though. I understand that it was surgery, but to me, it looks like she has holes in her actual cheek rather than her gum line. Is that the norm? I just tried calling the surgeon, but they are gone for the day and he didn't mention holes in her actual cheeks. Thank you so much for replying!
Hi Crystal - Sometimes the wisdom teeth have nowhere to go so they start to try to come into the mouth sideways. My guess is that the holes were made right over where the wisdom teeth were, so if it looks like the hole is on the cheek side of the gums, that's probably why.
I hope that helps - let me know if you have any other questions.
sorry, reading further, I believe it is called horizontal impact, to explain the way her teeth are growing. again, any feedback would help.
thanks
I feel a bit depressed at what I perceive as the poor service from my UK dentist even though he is a nice and friendly man . An extract of my letter to him hereunder illustrates why I am unhappy . He did not wish to respond at my appointment and maybe thought my comments were unfair. He now says just to live with the mild pain/diccomfort until it is necessary to extrat the wisdom tooth and that will also mean losing the tooth he did RCT on ( not cheap !) and also probably the tooth adjoining that one ( first molar I think ) as close to the RCT tooth ! Do you think his advice is correct please ? By "end" tooth , I meant the one which was root filled .
"Following our phone call and subsequent chat outside the surgery , I have been thinking about the situation this weekend and find it a bit depressing . To be perfectly honest I am not thrilled about the course of events . The pain started in January and you initially did a filling which did not alleviate the pain and you then recommended root canal treatment which was carried out on 21st january .. But I was then blissfully unaware of the reason for the pain , ie wisdom tooth .. It was not until 20th May at your surgery that you mentioned the wisdom tooth ( not being straight ) as the cause ( shown on x-ray taken prior to the RCT ) and prescribed antibiotic tablets to solve the mild pain/discomfort in the root filled tooth and gum which I had experienced since the RCT work.( but the tablets had virtually no effect unfortunately). If I had been told before RCT carried out that the reason for the pain in end tooth was the impacted wisdom tooth , I could have discussed the options and made an INFORMED choice between 1. extraction of end tooth and 2. saving the end tooth by having RCT followed at a later date by extraction due to the wisdom tooth continuing to cause problems for the end tooth necessitating it's extraction too ( your letter of 8th June refers to ultimate removal of the wisdom tooth and you said that would mean the end tooth would lack support and would loosen and have to also be extracted ). If I had had the choice I might well have chosen option 1 for obvious reasons including wasting money by doing RCT on a tooth which might have to be extracted not long afterwards . "
Hi Barry - Usually we do some tests on the tooth before we do a root canal to make sure that it is that tooth that is causing the pain. If we can't figure out if it really is that tooth, then we inform the patient and let them make the decision. I'm sorry if you weren't informed about the wisdom tooth before the root canal was done. Hopefully everything gets worked out.
Does the "end tooth" necessarily need to come out if the wisdom tooth is removed? You might ask to see what would happen if only the wisdom tooth was removed (how long would the "end tooth" last?)
I hope that helps. Let me know if you have any other questions. Thanks for your comment, Barry!
dear Tom,
thanks a lot for replying but it seems I did not explain it too well. The impacted wisdom tooth is not straight and pressed against the adjoining tooth causing decay eventually and then presumably root damage ( suddenly became painful ) necessitating RCT . If the wisdom tooth is now extracted ( dentist says it will ultimately have to be ) , it is necessary to use the adjoining tooth which was root filled for leverage and that tooth will then probably and need to be extracted too !
I am 69 and only wish the wisdom tooth had been extracted when I was young but I was unaware of what wisdom tooth even meant in those days !
Another big concern is the complex procedure to extract a wisdom tooth in an older person and it can result in nerve damage and affect speech . that is a big worry and I hope I can keep the status quo for a while as I now try to brush the wisdom tooth even though it only feels like it only started pushing through the gum.In your experience, what percentage of older people have nerve damage when an impacted or partially impacted wisdom tooth is extracted ?
thanking you in anticipation of your response .
barry
Hi Barry - To be honest, I don't have any experience in extracting wisdom teeth in older people. Our general rule at my dental school is that if they're not causing problems and the patient is over 35, then we leave them in. At my school, your case would be referred to an oral and maxillofacial surgery resident.
It would seem that it might be possible to remove some bone behind the tooth and surgically extract it without using the second molar as leverage. When we learn to extract teeth, they tell us to never use an adjacent tooth as leverage, always use bone. Of course there may be exceptions to this, since every person is different.
Have you tried getting a second opinion? That's the only suggestion I can offer. I hope that helps. Let me know if you have any other questions. Thanks for your comment, Barry!
I concluded from the article the wisdom teeth have only negative impacts,my question is if these teeth are only dangerous why we have them?
Hi Ahmed - One theory that I've heard is that in prehistoric times, many people would lose their teeth and not be able to chew very well. By having these extra teeth come in around the age of 20, they were viewed as "replacement" teeth so that the person could chew. Since other teeth had already fallen out, there was room for the wisdom teeth to come in. Also, I've heard that jaws were bigger back then and there was more room for wisdom teeth.
Just speculation. I'm not exactly sure why we have wisdom teeth! Some people even have an extra set of teeth behind their wisdom teeth and there are also people who don't even have wisdom teeth... I hope that helps, somewhat! Let me know if you have any other questions. Thanks for your comment, Ahmed!
Hi there. I got my one and only wisdom tooth (#32) removed 6 days ago and I'm experiencing pain along my jaw and cheek area, so much pain that it wakes me up in the middle of the night and my Hydrocodon (Vicodin generic meds) are barely helping the pain. I also noticed a bad smell and taste in that area and yesterday discovered what looked like a hole in the side of my cheek by the extraction site. I assume food particles got in there even though I swish warm salt water around in my mouth after eating but it only helps for a little while. I even tried to use the plastic syringe (filled with warm water) in the hole by squirting at it but nothing is coming out and the taste/smell still remains. I'm going in tomorrow to get it checked out but I've been searching through message boards and haven't found anything that sounds exactly like my problem, so I wanted to post this and see what other opinion I could get. Thanks.
Hi Tam - It sounds to me like the classic symptoms of dry socket. That's when the clot gets dislodged and the nerve that used to go into the tooth is exposed, thus causing lots of pain. It's much more common in the lower jaw, which is where #32 is.
I hope everything got taken care of when you went in and that you're healing nicely now!
hi Tom,
thanks a lot for your comments and suggestion and it was nice of you to respond. I am battling on at present as the dentists here do not know why I have mild pain and do not receommend removing wisdom tooth until it causes greater pain . thanks again and for this useful site .
I'm glad it helped. Good luck in the future with your dental work!
Thanks Tom for responding! The dentist thought it was dry socket at first too until he sprayed cold water over the area (and it didn't cause me pain), and when I mentioned that that side of my face is soothed by moist heat he mentioned that it must be muscle reactions from the muscle in our faces which help us smile (forgot what scientific name he termed it as). So he recommended that I apply moist heat everyday for 15 minutes and then massage the area and its been working thank goodness. And the hole that was in the area at what looked like in my cheek, was made because it was necessary to do so for the extraction so the dentist also advised that I clean it out a few times after everything I eat so the hole will heal and the taste/smell will go away. Hope everyone who has this problem is able to see my post and learn from it about what to do in case such an occurrence happens to you!
Hi Tam - Thanks for the update! Hopefully that will help out others who experience a similar problem, but don't have dry socket.
Hi Tom- Im 23 and i recently got my wisdoms removed. However, they discovered an OKC in my lower jaw and a cystsectomy was performed to remove it. Now the surgeon says i have to get it monitored by him. I was wondering how common is this cyst? Also, Can I have it monitored by my dentist who uses a regular panoramic xray instead of the oral surgeon who uses the icat?
Thanks Tom
Hi Stephen - I looked through many textbooks and papers trying to find out how common Odontogenic Keratocysts are. The best I could do was the following statement in Regezi's Oral Pathology textbook: "Solitary cysts—common (5%–15% of odontogenic cysts)" I am writing an article for tomorrow on OKC's so check back then and see if I figured it out!
The icat system does give you more radiation than a panoramic x-ray would, but it would give a clearer picture without distortion. It's a trade-off. If the OKC does recur, it may be caught earlier using a CBCT compared to a regular x-ray, or it may not. Also, the CBCT will give you more radiation. Still, I don't see why your regular dentist wouldn't' be able to monitor it, unless he/she feels uncomfortable monitoring it. Since about 1/3 of OKC's can recur, it is important to monitor it closely.
I hope that helps - Let me know if you have any other questions. Thanks for your comment, Stephen.
Hi Tom,
I had an Odontogenic Keratocyst (Parakeratotic Type) last molar, upper jaw, extracted about 4 months back. 10 days ago i was recommended a biopsy.
The microscopic findings are mentioned as follows:
Shows fragments of cyst lining. Some areas are lined by squamous epithelium covered with parakeratin. One fragments shows dilated cyst filled with keratious material. However remaining fragments shows reticulation of epithelial lining and heavy chronic inflammation of cyst wall. Small islands of odontogenic epithelium are present in the cyst wall. There is mid nuclear atypia.
My maxillofacial surgeon (dentist) is recommending another surgery by applying some sort of chemical in that area. He also mentioned that he may have to extract my last upper molar, the need arises, as access to the infected area is very difficult.
Please advise if you think this is a good recommendation.